Stroke system of care trial: a cluster randomised trial evaluation of a patient and carer-centred system of Longer-Term Stroke Care

ISRCTN ISRCTN67932305
DOI https://doi.org/10.1186/ISRCTN67932305
Secondary identifying numbers RP-PG-0606-1128
Submission date
04/04/2008
Registration date
09/05/2008
Last edited
13/07/2015
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Study website

Contact information

Prof Anne Forster
Scientific

Academic Unit of Elderly Care and Rehabilitation
Bradford Institute for Health Research
Temple Bank House
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
United Kingdom

Phone +44 (0)1274 383 406
Email a.forster@leeds.ac.uk

Study information

Study designPragmatic multi-centre cluster randomised controlled trial
Primary study designInterventional
Secondary study designCluster randomised trial
Study setting(s)Community
Study typeQuality of life
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleStroke system of care trial: a cluster randomised trial evaluation of a patient and carer-centred system of Longer-Term Stroke Care
Study acronymLoTS Care
Study objectivesThe hypothesis for LoTS Care is that a system of care delivered by a Stroke Care Co-ordinator (SCC) to patients and carers living at home, in the community, will improve psychological and functional outcomes compared to usual SCC practice.

The primary objective of the trial is to determine whether the system of care improves psychological outcomes for patients requiring long term care at home.

The secondary objectives include:
1. Improved functional outcomes for patients requiring long-term support at home
2. Improved psychological and functional outcomes for carers of patients requiring long term support at home
3. Cost effectiveness
Ethics approval(s)Leeds (West) Research Ethics Committee, 09/05/2008, ref: 08/H1307/43
Health condition(s) or problem(s) studiedStroke
InterventionStroke services will be randomised into intervention or control groups using the stratification factors of quality of the stroke unit; referral rate and SCCs working alone versus within a community multidisciplinary team.

SCCs in stroke services randomised to the intervention group will be trained to deliver a system of care centered on key problems identified as of central importance to stroke patients and their carers. The assessment schedule is presented in a manual comprising 16 questions (patient) and 11 questions (carer) representing the identified problem areas, linked to reference guides containing educational text with algorithms of evidence based treatment options and associated patient carer action plans. Implementation of the assessment system is supported by a specific training programme.

SCCs in stroke services randomised to the control group will continue to deliver current community-based practice as determined by local policy and practice.

The SCC will undertake a primary assessment of patients (and carer if appropriate) using the system of care and instigate service responses, with additional follow-up and monitoring visits as appropriate to the needs of individual patients. Therefore there are no specified treatment times for either arms. Follow up of both the control and intervention arms of the patients (and carers if applicable) will be followed up at 6 and 12 months.
Intervention typeOther
Primary outcome measureGeneral Health Questionnaire 12 (GHQ12) completed by the patient 6 months after recruitment
Secondary outcome measuresThe secondary outcome measures for patients at 6 and 12 months are:
1. Frenchay Activities Index
2. Barthel Index
3. EQ-5D
4. Stroke Impact Scale
5. Longer-term Unmet Need in Stroke
6. Satisfaction
7. Death
8. Hospital re-admission
9. Institutionalisation
10. Total costs
11. Cost-effectiveness/cost-utility

The GHQ12 at 12 months is also a patient secondary outcome measure to assess whether any intervention effect is sustained.

The secondary outcome measures for carers at 6 and 12 months are:
1. GHQ12
2. Carer Burden Scale
3. Satisfaction
4. Death
5. Institutionalisation
Overall study start date01/06/2008
Completion date30/04/2012

Eligibility

Participant type(s)Patient
Age groupNot Specified
SexNot Specified
Target number of participants800 patients (and carers if applicable)
Key inclusion criteriaThe trial is evaluating a complex intervention delivered by the Stroke Care Co-ordinator (SCC) within a stroke service and eligibility criteria apply at three levels - the stroke service, the stroke unit and the SCC.

A stroke service will only be considered for inclusion in the trial if it includes a stroke unit which fulfils the Royal College of Physicians guidelines definition of a stroke unit, that is, by the presence of 4/5 of the following criteria:
1. Consultant physician with responsibility for stroke
2. Formal links with patient and carer organisations
3. Multidisciplinary meetings at least weekly to plan patient care
4. Provision of information to patients about stroke
5. Continuing education programmes for staff

Stroke Care Co-ordinators (SCC) will be eligible if they fulfill the following criteria:
1. A registered healthcare professional with documented experience in stroke care
2. Undertakes a community based liaison or co-ordinating role for stroke patients
3. Co-ordinates a range of longer-term care inputs on the patients' and carers' behalf (e.g., signposting, carrying out assessments)
4. Works within a stroke service as above

Patients with the following characteristics will be eligible for the trial:
1. Have a confirmed primary diagnosis of stroke
2. Are referred to a SCC on discharge home from hospital or within six weeks of stroke
3. Are still waiting for their first SCC assessment visit
4. Provide written informed consent or carer assent

All carers with the following characteristics are eligible for this study:
1. Identified by the patient
2. Eligible for this study
3. Provides the patient with practical support on at least a weekly basis
Key exclusion criteriaPatients will be excluded from the trial if:
1. They are unlikely to survive for more than three months
2. Are being discharged to/resident in a nursing or residential home
3. Have been previously registered to the trial
4. They are taking part in other stroke research network adopted studies which involve 6- and 12-month follow-up questionnaires
Date of first enrolment01/06/2008
Date of final enrolment30/04/2012

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Bradford Institute for Health Research
Bradford
BD9 6RJ
United Kingdom

Sponsor information

Bradford Teaching Hospitals NHS Foundation Trust (UK)
Hospital/treatment centre

c/o John Wright
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
England
United Kingdom

Phone +44 (0)1274 364279
Email j.wright@bradfordhospitals.nhs.uk
Website http://www.bradfordhospitals.nhs.uk/
ROR logo "ROR" https://ror.org/05gekvn04

Funders

Funder type

Government

National Institute for Health Research
Government organisation / National government
Alternative name(s)
National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
Location
United Kingdom
Stroke Association
Private sector organisation / Associations and societies (private and public)
Location
United Kingdom

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/12/2014 Yes No
Results article results 01/08/2015 Yes No